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Poor Sensitivity for Clinician Suspicion of Alcohol Problem

Suspicion has sensitivity of 27 percent, specificity of 98 percent, positive predictive value of 62 percent

TUESDAY, Jan. 22 (HealthDay News) -- Primary care physicians' clinical suspicion of an alcohol problem has high specificity, but poor sensitivity, according to research published in the January/February issue of the Annals of Family Medicine.

To evaluate the sensitivity, specificity, and predictive values of clinician suspicion compared with screening-detected alcohol problems in patients, Daniel C. Vinson, M.D., M.S.P.H., of the University of Missouri in Columbia, and colleagues conducted a cross-sectional study involving 1,669 patients visiting 94 primary care clinicians' offices.

The researchers found that, using a validated screening instrument, 10.1 percent of patients (171) screened positive for hazardous drinking and 3.8 percent (64) were positive for harmful drinking. Based on clinical suspicion, 81 patients were identified as having alcohol problems (hazardous drinking, 37; harmful drinking, 40; both, four). The sensitivity and specificity of clinical suspicion of hazardous or harmful drinking were 27 and 98 percent, respectively. The positive predictive value was 62 percent and the negative predictive value was 92 percent.

"Our study affirms that systems need to be in place, possibly through team-based care, to screen systematically for alcohol problems with a validated question or series of questions and to address this health threat using evidence-based approaches," the authors write. "This process can improve patient health and perhaps save some of the $223 billion economic cost of alcohol in the United States (in 2006)."

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